Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.

Monday, April 03, 2017

Roy on the Pros and Cons of Medical Marijuana

Medical marijuana was legalized in Maryland two years ago, and this summer we will be getting our first dispensaries. Psychiatrists are starting to ask what this means in terms of treating patients. Roy did a great job summing up some of the research for our colleagues:Unfortunately, because of the many historical restrictions on research,
there is increasing amounts of data available, yet few "facts" to go by
("fact" as in "a thing that is indisputably the case"). These data are
often viewed from differing perspectives. Such as absolute vs relative
risks. Harm reduction vs harm avoidance. Public health vs
criminalization perspectives. Use vs abuse (eg, plenty people use
alcohol without abuse it, getting drunk, rotting their liver... same
with cannabis).

That being said, the National Academy
of Science and Medicine just put out in January a comprehensive (500 pages) reporton the health risks of cannabis. I have attached the 3MB
pdf file for our MPS readers' enjoyment. They found about 10,000
relevant abstracts to review (leaving out another 10,000 that did not
meet their quality review). I was surprised there was that much out
there.

I'll boil it down to the Executive Summary level.
Their major conclusion appears to be that, essentially, we need more
research. Beyond that, they divided up additional findings based on the
strength and quality of the research:

Strongest evidence:

There is conclusive or substantial evidence that cannabis or cannabinoids are effective:

For the treatment of chronic pain in adults (cannabis) (4-1)

As antiemetics in the treatment of chemotherapy-induced nausea and vomiting (oral cannabinoids) (4-3)

The
above is from the first page of about 10 pages of summary findings,
including findings of both benefit and risk that are in the Exec Summary
of the document. If still interested, turn to pages 13 to 22 to read
the rest. And dive deeper if you are really interested.

As
for patient education, I think one could turn these 10 pages into maybe
2 pages of "here is what we know and here is what we don't know". Of
course, where one draws the dividing line is arbitrary, but start with
those things that have the strongest evidence, with benefits on the left
and risks on the right.

Then people make up
their own mind, like anything else... a risk/benefit discussion. Would
you risk liver failure for headache relief? Here's two Tylenol (or four
or six).

6 comments:

As you noted above, medical marijuana certainly has an application to somatic issues. That said, the psychiatric / mental health ones are nefarious at best.

This legalization of medical marijuana as well as recreational marijuana for the masses is just an excuse for hardcore dopers to think they can smoke pot and be dumbasses. People who recreationally use pot don't need it legalized and don't want to flaunt it, they just want to be able to smoke in the privacy of their homes and enjoy life quietly and uninterrupted.

Thus why decriminalization is the way to go.

Legalization is strictly about people who want to get high and be lame!

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